Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD-46125 | IA |
N | 207QS0010X | Family Doctor - Sports Medicine | MD-46125 | IA |
NPI | 1336501402 |
---|---|
Provider Name | Tyler Grant Slayman |
First Address | Iowa City, IA 52242-1009 |
Second Address | Coralville, IA 52241-2225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2016 |
Last Update Date | 06/07/2020 |